As a Pediatrician, I Know There’s No Way to Jail Migrant Families Without Hurting Kids

If we really care about migrant kids, we can’t stop at ending the obvious atrocity of family separation at the border.

Shoes and a teddy bear, brought by a group of U.S. mayors, are piled up outside a holding facility for immigrant children in Tornillo. AP Photo/Andres Leighton

In my daily life as a pediatrician, I sometimes care for kids who have been removed from their homes — just the day before, or even that same day — by Child Protective Services. These kids arrive in my office in Seattle accompanied by a volunteer from a local shelter that offers them temporary housing. In this sense, they are fortunate: Unlike many such children in my home state of Texas, kids in Seattle don’t spend those first scary nights sleeping in a hotel, or a police station, or a caseworker’s office.

Fortune is relative, of course. They are removed from their homes because they have been abused or neglected. Every single one of them, every time, is traumatized.

They share this with the asylum-seeking kids whom our government has detained. Those kids were traumatized by exposure to violence and poverty at home; some were harmed during migration; many were traumatized again by forced separation from their parents. Like my patients, asylum-seeking kids face an uncertain future. Will they find safe shelter in American communities with the parents who love them enough to leave everything they knew behind and seek asylum here, or will they be imprisoned in family detention centers?

My job is to do a basic physical exam, document signs of abuse and try to equip kids with appropriate medical care for their first 30 days as wards of the state. (Once they’re placed with a family, they’ll find a regular pediatrician.) Documenting signs of abuse is easy enough. But offering medical care to a child without his or her parent is nearly impossible.

In order to be safe, kids need people who love them — parents, not prison guards — to be the ultimate authorities in their worlds.

Many young children don’t use language yet. Traumatized kids are even quieter. They may regress into a pre-verbal state, or be so afraid of any stranger that they don’t say a word. (Worse, they may be so desperate for affection that they run into my arms. They may have learned that cuteness, and sweetness, can protect them from getting hit.)

Kids who don’t speak have no way of telling me about their medical needs. They don’t come with medical records, and they don’t come with any medicines they might have been taking. I have no way of knowing, as I examine a 15-month-old boy, if a seizure disorder is fritzing within his brain, waiting for the moment when it will send him crashing and shaking onto the floor. If I ask him, “Do you take any medicines?” he’ll just frown at me and keep on banging one Lego into another.

I have no way of knowing what heart surgery led to that scar in the middle of a child’s chest. Does this kid need albuterol to fend off an asthma attack? How long has this rash been spreading? Can this little girl even hear?

Older kids are challenging, too. They don’t know the names of their medicines and can’t explain what surgeries they’ve had. They’ve lived long enough to know that, no matter how good my intentions are, I can’t provide the help they really need.

It is impossible to do this job well, and sometimes I wake at night worried about these kids: What have I missed? What were they unable to tell me? It is impossible to provide adequate medical care to children without their parents. Parents are not only the people who (in most cases) love and care for their children best; they are also the repositories of a child’s medical history. They know the signs of illness in their particular kid. They are the only way that children can be kept safe.

The notion that we as a country can keep migrant children safe without their parents is laughable. The kids who have already been separated from their parents cannot be kept safe, even if they do have access to medical care. The migrant kids who stay in shelters while their parents are in detention centers cannot get appropriate medicine.

Nor is it safe to detain whole families. Mothers detained in the immigrant women’s prison in Hutto and the family detention center in Karnes City — both for-profit facilities in Texas — have described being unable to keep their own kids safe in those prisons. The kids lose weight. They are sexually abused. Toddlers who should be eating table foods survive on breastmilk because they just won’t take the prison food. In order to be safe, kids need people who love them — parents, not prison guards — to be the ultimate authorities in their worlds.

There are more pedestrian dangers, too, to the disruption of parental authority that family detention imposes. I know a 6-month-old is ready to start table foods when she begins showing interest at family meals: Can that happen in prison? Four-year-olds need clear boundaries controlled by their parents so they can learn right from wrong. Every kid needs a parent to reassure them that it is safe for a doctor to examine their privates, but not anybody else. Parents must have authority over who gets to touch their children.

There is no way to practice routine immigrant detention without hurting kids and families. When we detain, prosecute and deport men, we are starving the women and children they care for.

If we really care about migrant kids, we can’t stop at ending the obvious atrocity of family separation at the border. We have to go a step further, and end the whole practice of immigrant detention. Every person — one way or another — leads back to a family, and every family leads back to a child. Mercy for the kids at the border requires mercy for their parents, too.

Rachel Pearson, M.D., Ph.D., is a native Texan and a pediatrics resident. She wrote No Apparent Distress: A Doctor’s Coming-of-Age on the Front Lines of American Medicine.